Name: Edward B. Lack, M.D., S.C.
Occupation: Dermatologist
Background: Born in Chicago, Lack, 45, earned his medical degree at the University of Missouri in 1969. He served as a family practitioner and as an emergency room doctor before starting his own dermatology practice in 1973. Lack, whose practice is in Des Plaines, lives in Highland Park with his wife and 9-year-old son.
Years in present position: 17
When I first started in practice, and up until recently, patients thought that dermatologists were not doctors. Often a patient would come in, and he`d have something wrong that was related to a respiratory infection, or whatever, and I`d say I want to listen to his lungs and he would say, ”Well, I`ll see my real doctor for that.”
My background had been in family practice and three years of emergency medicine. So I felt like a ”real” doctor, and I resented that attitude, as did a lot of dermatologists around the country. Now, because of the work we`ve done in immunology, especially in cancer, and now that we`ve become fairly proficient surgeons, I think we`re perceived pretty much by the public as ”real” doctors.
We dermatologists pioneered hair transplants. We pioneered liposuction. We did a lot of the pioneering work in sclerotherapy (treatment of varicose veins). After we got more proficient in those areas, we started teaching and setting up postgraduate courses. And that`s how I came to expand my own training. I do surgery and I do a lot of counseling and I work in
cosmetology-making people look better and feel better. We are family practitioners of the skin. If it has skin, I do it. It isn`t that I know everything; it`s that there`s no one better trained to help with the skin.
Sometimes we`re dealing with people who have multisystem disease. Maybe they have something wrong with the liver, the kidney and the skin. Maybe they have diabetes. Well, then you have to have a team of doctors. None of us knows enough to manage it all.
Practicing medicine is very satisfying. You have a patient who suffers, you do something, the patient gets well, and you get a lot of gratitude from that person, in most cases. This is fun because it`s exciting and there`s a beginning and an end.
Of course there are some aspects to this profession that I don`t like. I don`t like it when people get upset with me because they`re carrying problems from home or they had to wait a while in the waiting room. Waiting in the waiting room is always the crucial issue people focus on. I don`t like being accused of trying to inconvenience them when my only goal and role here is to help people.
Another major negative aspect to this profession is related to the adversarial environment in which we live. Many patients come in with a hostile attitude. They let you know that they have ”a lawyer.” Some will make a snide remark, such as, ”You know, if you don`t do well, I`m going to sue you.” To be sure, this is a minority, and most of my patients are not like that. Maybe it`s two or three people in a day. But they take so much emotional energy out of you. They always upset the front-office staff, too.
This constant fear of a lawsuit is very real. In this country, because the loser does not have to pay for court costs, you can sue with absolute abandon. You have no penalty, and, therefore, the majority of lawsuits against doctors are frivolous. Also, there is an attitude that you should be rewarded for your injury. Not just a restitution, enough money to help you get well, but a reward, as if you had won a lottery.
On a typical day I get up around 6 a.m. and leave the house by 6:30 or 6:45. I`m at either Holy Family or Lutheran General Hospital by 7:15 or 7:30. I have breakfast with employees or with the few doctors who might be around, and then I come to the office. I`ll see patients for three to four hours and then we take a break, at which time I`ll take 15 to eat and 45 minutes to do administrative work. Then we`ll resume seeing patients for another three to four hours. After that I do paperwork and make phone calls for another hour. The phone calls could be to get test results or maybe because I got a test result and I don`t believe it and I have to find out why it was the way it was. Then I may have to go to the hospital to do consultations on other doctors` patients. If I`m lucky I`ll get out at 5:30. If not, it might be 6:30 or 7. If I have committee meetings, those would either start my day or end my day. Sometimes I`m teaching or have a resident working with me to watch and learn.
The most common reasons people see a skin doctor are to look better or to feel better. They`re itching and they`re uncomfortable. Or they want to look better and they may or may not have a disease. Acne, for instance, is a typical reason to consult a dermatologist.
Today almost every patient can be cleared of acne. But the definition of clear is what we have to decide upon. For a 15-year-old who has a couple of pimples, it is not worth putting that adolescent on large amounts of medicine, and I, personally, won`t do it. But, also, it is not appropriate to let a child suffer with cystic acne when he is scarred and disfigured and unable to compete in life, when we have the complete ability to clear up his skin. We have topical agents, various antibiotics and a drug called Accutane, which is a derivative of Vitamin A and essentially cures 85 percent of all people who take it and which can put every single kid in remission. It is up to the doctor to decide who really needs it and who doesn`t. It has numerous side effects, not the least of which is that it causes birth defects if a woman gets pregnant while taking the drug.
Questions about suntanning are a major concern to my patients. We are in an epidemic of skin cancer in the world. There are almost 600,000 new skin cancers every year in the United States alone. One out of every three cases of cancer in the U.S. is in the skin. Almost 8,000 people a year die of skin cancer. While we can`t tell how many of these are caused by exposure to the sun, we do know that pollution has caused enough depletion of the ozone layer of the atmosphere that there`s a drastically increased quantity of ultraviolet radiation hitting the entire Earth.
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And then there is this incredible aberration called tanning parlors. Here the person is exposed to ultraviolet A radiation, which is the longest ultraviolet radiation there is. It not only goes through the skin-the epidermis-it goes into the dermis, into the blood vessels and into the white blood cells that percolate through the skin. It not only prematurely ages the skin, it not only causes skin cancer and malignant melanoma, it depresses the immune system. And in the long run it may be the depressed immune system, 20 years from now, that will tell the ultimate story of the harm of ultraviolet A radiation. When you are exposed to these rays, you are simulating, for a short amount of time, an immune-depressed state, which in some fashion is analogous to AIDS. And people do this willingly.
Also, the ultraviolet A radiation bypasses the normal body safety mechanisms to protect you from ultraviolet radiation. If you go outside in the sun, you`re exposed to more ultraviolet B than A. Ultraviolet B radiation causes the skin to thicken, and that thickening makes it harder for the radiation to penetrate through the skin. The thickening of the skin, not a suntan, is what protects your skin. Ultraviolet A radiation, which you get in tanning parlors, does not cause the thickening of the skin. Therefore, people get more radiation and more poisoning this way. So tanning booths are not safer than sunlight, as is so often claimed.
I would advise people to use a No. 15 sunscreen and to keep covered up as much as possible when they`re out in the sun. But don`t forget that the sun is essential for life. Emotionally, you need sunlight to be well-balanced and happy. It`s also important for Vitamin D metabolism and regulation of calcium. When I explained all this to a patient of mine who had skin cancer, he put his boat up for sale and got very depressed. I said, ”Look, I told you to wear a hat. I didn`t say you had to sell your boat.”
The thing that keeps me going in this job is all the variety. And being able to go different places and find out new ways to do things, bring them back here and make available the things that people would normally have to travel for. That`s sort of been my mission, and that`s the fun of it. c8